[Treatment of aggressive primary lymphomas of the digestive system by intensive chemotherapy. Experience of the Study Group on Lymphomas in Adults with the LNH-84 protocol].

Ninety-one patients with primary gastrointestinal lymphoma included in the LNH-84 multicentric regimen were analyzed to determine the efficacy and the toxicity of intensive combination chemotherapy and of surgical debulking. All these patients had aggressive histological subtypes: 56 patients had localize disease, stage IE or IIE, and 35 patients had stage IV disease; 40 patients had bulky disease. Specific sites included stomach (43 cases), small bowel (35), ileo-cecum (13), colon (10), and rectum (6). Although 71 patients (78%) had an attempted surgical resection, only 28 (31%) had complete tumor excision. Patients were treated with 3 or 4 cycles of ACVB chemotherapy followed by sequential consolidation. Nine patients died during chemotherapy. With a median follow-up of 3 years, 10 patients have relapsed and predicted 4-year survival of the entire group is 62%. In stage IE or IIE patients, survival and disease-free survival are similar in patients who underwent complete resection or incomplete or no surgical resection prior to the administration of chemotherapy. Prognostic factors predicting for survival were similar to the entire group of patients treated with the LNH-84 regimen. Aggressive gastrointestinal lymphoma patients treated with intensive chemotherapy have outcome and prognostic factors comparable to those of other similarly staged aggressive lymphoma patients. Surgical resection prior to the administration of combination chemotherapy did not influence survival or disease-free survival in patients with localized disease.